Oregon s Whole System Change: Opportunities to integrate a population health approach in transformation and ACA implementation

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1 Oregon s Whole System Change: Opportunities to integrate a population health approach in transformation and ACA implementation Lillian Shirley, BSN, MPH, MPA Director, Multnomah County Health Department Vice Chair, Oregon Health Policy Board June 13, 2013

2 Improving Population Health Outcome Depends on Transforming the Health System to Coordinate and Integrate Primary Care, Public Health and Community Preventative Efforts Payers, Insurers and ACOs Health Care System/Primary Care Community Prevention/ Social Determinants of Health (SDOH), Education Public Health Improved Population Health, Health Outcomes & Lower Costs (Triple Aim) Thanks to TFAH & California Endowment & Kresge Foundation

3 Coordinated Care Organization Service Area

4 Health System Transformation: Oregon s Commitment to CMS Core Metrics Reduce the annual increase in the cost of care (the cost curve) by 2 percentage points Ensure that quality of care improves Ensure that population health improves Establish a quality incentive pool that increases every year as a percentage of the global budget Commitment to measurement Public reporting of metrics by CCO

5 Health System Transformation: Oregon s Commitment to CMS Core Metrics CCO Incentive Measures Annual assessment of CCO performance on 17 measures Will Compare performance in CY 2013 to CY 2011 baseline Quality pool funds available to CCOs based on performance; up to 2% of their global budget in first year State Performance Measures Annual assessment of statewide performance on CCO measures and an additional 16 metrics Financial penalties to the state if quality goals are not achieved

6 Statewide Quality and Access Metrics: ROI Seven Quality Improvement Focus Areas Improving behavioral and physical health coordination Improving prenatal and maternity care Reducing preventable re-hospitalizations Ensuring appropriate care is delivered in appropriate settings Reducing preventable and unnecessarily costly utilization by super-users Addressing discrete health issues (such as asthma, diabetes, high blood pressure) Improving primary care for all populations

7 Attributes of CCO and ACO Systems of Care Best Practices to Manage and Coordinate Care Single point of accountability Patient and family-centered care Team-based care that cross appropriate disciplines Plans for managing care for 20% of population driving 80% of costs Plans for prevention and wellness, including addressing disparities among population served Broad adoption and use of electronic health records

8 Attributes of CCO and ACO Systems of Care cont. Sharing Responsibility for Health Shared decision-making for care among patients and providers Consumer/patient education and accountability strategies Consumer/patient responsibility for personal health behaviors Measuring Performance Demonstrated understanding of population served Quality, cost and access metrics Strategies for targets and improvement

9 Attributes of CCO and ACO Systems of Care cont. Paying for Outcomes and Health Payments aligned to outcomes not volume Incentives for prevention and improved care of chronic illness Providing Information Readily available, accurate, reliable and understandable cost and quality data Price and value for payers, providers and patients Sustainable Rate of Growth Focused on preventing cost shifts to employers, individuals and families Reduced utilization and cost trend

10 Multnomah County Diabetes Prevention through Care Multnomah County adult population Interventions at the Intersections 584,651 Multnomah County adults at high risk for diabetes 323,312 Adults diagnosed with diabetes 35,079 Privately insured adults 23,324 Adults on OHP/ Medicaid 6,388 Insured receiving care 20,992 OHP/ Medicaid receiving care 5,749 Uninsured/ self pay adults Uninsured adults receiving care 5,367 4,830

11 Multnomah County Prevention System: Diabetes Multnomah County Population Primary Prevention Individual-level: Health education Community-level: Healthy Retail Initiative School-based healthy eating Safe routes to school Policy-level: Health considered in built environment decisions Health Impact Assessments High Risk for Diabetes Secondary Prevention Individual-level Health education Health screening Community & Policy levels Same as for primary prev. Diagnosed with Diabetes Privately Insured OHP/ Medicaid Uninsured Insured receiving care OHP/ Medicaid receiving care Uninsured receiving care Tertiary Prevention Individual level Chronic disease self-management education Diabetes Care & Case Management

12 Leading Causes of Death Liver Disease: Tied for 9th in MC Payers, Insurers and ACOs Health Care System/Primary Care Community Prevention/ Social Determinants of Health (SDOH) Public Health Improved Population Health, Health Outcomes & Lower Costs (Triple Aim)

13 The Road Ahead

14 Governor's Charge 6/3/13 To the Health Policy Board: Create the environment for commercial market place in Oregon that is characterized by our models of coordinated care and growth rate of total health care expenditures that are reasonable and predictive

15 But It s About the People

16 Thank you! Lillian Shirley, BSN, MPH, MPA Director, Multnomah County Health Department 426 SW Stark St, 8 th floor Portland, Oregon Office: Lillian.m.shirley@multco.us Website:

17 Addendum Oregon s Action Plan for Health Created 2010: Progress Reports Quarterly Set a target for health care spending in Oregon Align purchasing Standardize certain provider payments to Medicare methodology to set stage for future payment reform Focus on quality and cost improvement efforts to achieve critical momentum Introduce innovative payment methods that reward efficiency and outcomes

18 Addendum Oregon s Action Plan for Health Created 2010: Progress Reports Quarterly cont. Reduce administrative costs in health care Decrease obesity and tobacco use Establish a mission-driven public corporation to serve as the legal entity for the Oregon health Insurance Exchange Promote local and regional accountability for health and health care

19 Addendum Oregon s Action Plan for Health Created 2010: Progress Reports Quarterly cont. Build the health care workforce Use loan repayment to attract and retain primary care providers in rural and underserved areas Standardize prerequisites for clinical training via a student passport Extend requirement to participate in Oregon s health care workforce database to all health professional licensing boards

20 Addendum Oregon s Action Plan for Health Created 2010: Progress Reports Quarterly cont. Move to patient-centered primary care (PCPCH), first for OHA lives (Medicaid, state employees, educators) and then statewide Introduce a value-based benefit design that removes barriers to preventative care Expand the use of health information technology (HIT) and exchange (HIE)

21 Addendum Oregon s Action Plan for Health Created 2010: Progress Reports Quarterly cont. Develop guidelines for clinical best practices Strengthen medical liability system Remove barriers to full disclosure of adverse events by providers and facilities Clarify that statements of regret or apology may not be used to prove negligence Performance measurement

22 Public Health Influence In Health Reform Implementation

23 Our Theory of Change: Public Health Leverage Points Shifting our focus to prevention Aligned purchasing and policy Local accountability Standards for safe and effective care Living within a budget Redesigned/ Transformed Delivery System Improved patient outcomes Healthier population Reduced health inequities Reduced costs/shared savings

24 Coordinated Care Organizations CCOs are local health entities that deliver health care and coverage Local control One point of accountability Global (single) budget Expected health outcomes Integrating physical and behavioral health Electronic health records Focus on prevention Reduced administrative overhead Community health workers Health equity Patient-centered primary care homes 6